#16
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Ïðèìåíèòåëüíî ê äàííîé ïàöèåíòêå áåññïîðíî íå î ÊÎÊ ðå÷ü - ïðèìåíèòåëüíî ê äðóãèì è â äðóãèõ ñèòóàöèÿõ îáñóäèì
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Ã.À. Ìåëüíè÷åíêî |
#17
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Öèòàòà:
Èíôåêöèîííûé ïðîöåññ ìîãóò âûçûâàòü íå òîëüêî ïðèøåäøèå èç âíå ìèêðîîðãàíèçìû, íî è ïîñòîÿííûå "ìèêðîæèòåëè" (â îáû÷íûõ óñëîâèÿõ íå âûçûâàþùèå íè÷åãî ïëîõîãî) Âàøåãî îðãàíèçìà ïðè îïðåäåëåííûõ óñëîâèÿõ. Ïîýòîìó ëîãè÷åñêàÿ öåïü Âàøèõ ðàññóæäåíèé íå ñîâñåì âåðíà, âåðíåå íå âåðíà ñîâñåì. ×òî æå êàñàåòñÿ ñòèìóëÿöèè è ëå÷åíèÿ ÑÏÊß. Âûøå Ãàëèíà Àôàíàñüåâíà óæå óïîìèíàëà î ò.í. êîíöåíñóñå â Ñàëîíèêàõ ïî ëå÷åíèþ ÑÏÊß (ïðîùå ãîâîðÿ ñúåõàëèñü ñïåöèàëèñòû è äîãîâîðèëèñü î òîì ÷òî òàêîå õîðîøî è ÷òî òàêîå ïëîõî ïðè ëå÷åíèè ÑÏÊß). Õîòåë áû íåìíîãî êîíêðåòèçèðîâàòü, ò.ê. â ðåêîìåíäàöèÿõ âðà÷åé åñòü ðàçíûå ìíåíèÿ. ß Òàêæå êàê è ä-ð Àíøèíà ïðåäïî÷èòàþ ãîíàäîòðîïèíû, îäíàêî ÷àùå ñëåäóþ ðåêîìåíäàöèÿì îñíîâàííûì íà äàííûõ äîêàçàòåëüíîé ìåäèöèíû. Äëÿ ÑÏÊß âêðàòöå ýòî âûãëÿäèò òàê: Ïåðåä íà÷àëîì ëþáîãî âìåøàòåëüñòâà ä.á. ðåêîìåíäîâàíî:
Ëå÷åíåì âòîðîé ëèíèè ÿâëÿåòñÿ ïðèìåíåíèå ýêçîãåííûõ ãîíàäîòðîïèíîâ èëè ëàïàðîñêîïè÷åñêàÿ õèðóðãèÿ (ëàïàðîñêîïè÷åñêàÿ õèðóðãèÿ äîëæíà îñóùåñòâëÿòñÿ ñ ïîñëåäóþùåé èíäóêöèåé îâóëÿöèè) Ëå÷åíèå òðåòüåé ëèíèè ÿâëÿåòñÿ ïðèìåíåíèå ýêî. Èñïîëüçîâàíèå Ìåòôîðìèíà ïðè ÑÏÊß äîëæíî áûòü îãðàíè÷åíî ó æåíùèí ñ îòñóòñòâèåì òîëåðàíòíîñòè ê ãëþêîçå. Ðóòèííîå èñïîëüçîâàíèå ýòîãî ëåêàðñòâåííîãî ñðåäñòâà â èíäóêöèè îâóëÿöèè íå ðåêîìåíäóåòñÿ. Íåò äîñòàòî÷íûõ äàííûõ, ÷òîáû ðåêîìåíäîâàòü êëèíè÷åñêîå èñïîëüçîâàíèå èíãèáèòîðîâ àðîìàòàç äëÿ îáû÷íîé èíäóêöèè îâóëÿöèè. "Consensus on infertility treatment related to polycystic ovary syndrome The Thessaloniki ESHRE/ASRM-Sponsored PCOS Consensus Workshop Group March 2–3, 2007, Thessaloniki, Greece" |
#18
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Öèòàòà:
: Cochrane Database Syst Rev. 2005 Jan 25;(1):CD002249. Links Oral anti-oestrogens and medical adjuncts for subfertility associated with anovulation.Beck JI, Boothroyd C, Proctor M, Farquhar C, Hughes E. BACKGROUND: Infertility due to anovulation is a common problem in women. The first line oral treatment is with anti-oestrogens, such as clomiphene citrate. Unfortunately there may be resistance and alternative and adjunctive treatments have been developed. These include tamoxifen, dexamethasone, bromocriptine and aromatase inhibitors (AIs). OBJECTIVES: To determine the relative effectiveness of anti-oestrogen agents, with or without medical adjuncts, in women with WHO group 2 anovulation. SEARCH STRATEGY: We searched the Cochrane Menstrual Disorders and Subfertility Group trial register (searched 5th July 2004), CENTRAL (The Cochrane Library Issue 2 2004), MEDLINE (1966 to June 2004) and EMBASE (1980 to June 2004) for identification of relevant randomised controlled trials (RCTs). Additionally the United Kingdom National Institute for Clinical Excellence (NICE) guidelines and the references of relevant reviews and RCTs were searched. SELECTION CRITERIA: RCTs that compare oral anti-oestrogen agents for ovulation induction (alone or in conjunction with medical adjuncts) in anovulatory subfertility, were considered for inclusion in the review. Metformin and other insulin sensitizing agents were not included. Hyperprolactinaemic infertility was not included. DATA COLLECTION AND ANALYSIS: Data extraction and quality assessment was done independently by two reviewers. The primary outcome was live birth, secondary outcomes were: pregnancy, ovulation, miscarriage, multiple pregnancy, overstimulation, ovarian hyperstimulation syndrome and patient reported adverse effects. MAIN RESULTS: Twelve RCTs were found and included in this review. No trials reported live birth as an outcome. Miscarriage and multiple pregnancy rates were poorly reported. Clomiphene was shown to be effective in increasing pregnancy rate when compared to placebo (fixed OR 5.8, 95% CI 1.6 to 21.5; NNT 5.9, 95% CI 3.6 to 16.7). No evidence of a difference in effect was found between clomiphene and tamoxifen (fixed OR 1.0, 95% CI 0.5 to 2.1). The use of clomiphene in combination with tamoxifen did not find any evidence of effect on pregnancy rate when compared to clomiphene alone (fixed OR 3.3, 95% CI 0.1 to 91.6). The comparison between two AIs (letrozole and anastrozole) did not find any evidence of a difference in effect on pregnancy rate (fixed OR 1.9, 95% CI 0.4 to 8.9). For the intervention of clomiphene plus ketoconazole vs clomiphene no evidence of a difference in effect for pregnancy rate was found (fixed OR 2.4, 95% CI 0.9 to 6.4). For clomiphene plus bromocriptine vs clomiphene no evidence of a difference in effect on pregnancy rate was found (fixed OR 1.0, 95% CI 0.3 to 3.0) rates. However, clomiphene plus dexamethasone treatment resulted in a significant improvement in the pregnancy rate (fixed OR 11.3, 95% CI 5.3 to 24.0; NNT 2.7, 95% CI 2.1 to 3.6) when compared to clomiphene alone as did clomiphene plus pretreatment with combined oral contraceptives (fixed OR 27.2, 95% CI 3.1 to 235.0; NNT 2.0, 95% CI 1.4 to 3.4). AUTHORS' CONCLUSIONS: This review shows evidence supporting the effectiveness of the current first line treatment, clomiphene citrate. No evidence of a difference in effect was found between clomiphene and tamoxifen. The use of dexamethasone as an adjunct to clomiphene therapy appears promising as do combined oral contraceptives. This review has highlighted a gap in the literature on effects of these drugs on outcomes such as miscarriage rate. Evidence in favour of these interventions is flawed. RCTs of adequate power and of high methodological quality are required for the older treatments such as clomiphene, alone and with medical adjuncts, and also for the newer drugs such as the AIs. Ýôôåêò ÊÎÊ çäåñü îáúÿñíèì ñ ïîçèöèé áëîêàäû îâàðèàëüíîé ôóíêöèè è ïîñëåäóþùåé åå íîðìàëèçàéèè ñ íîðìàëüíûìè ïîêàçàòåëÿìè àíäðîãåíîâ è ãîíàäîòðîïèíîâ (âî âðåìÿ ïðèåìà ÊÎÊ âðåìåííî áëîêèðóåòñÿ ðàçâèòèå íîâûõ ôîëëèêóëîâ, è ïðîèñõîäèò àòðåçèÿ òåõ ôîëëèêóëîâ, êîòîðûå èç-çà èçáûòêà àíäðîãåíîâ îñòàíîâèëèñü íà ïîëïóòè â ñâîåì ðàçâèòèè. òî åñòü íîðìàëèçóåòñÿ è ñòðóêòóðà è, ñîîòâåòñòâåííî, ôóíêöèîíàëüíîå ñîñòîÿíèå - ýòî - âðåìåííî, ê ñîæàëåíèþ). Íî âîñïîëüçîâàòüñÿ ýòèì ôåíîìåíîì ñ ïîëüçîé äëÿ äåëà ìîæíî. |
#19
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Öèòàòà:
[Ññûëêè äîñòóïíû òîëüêî çàðåãèñòðèðîâàííûì ïîëüçîâàòåëÿì ] Â áëèæàéøåì íîìåðå áóäåò îïóáëèêîâàíî îáñóæäåíèå äàíîãî êîíñåíñóñà. Íî âåäü âñå, ÷òî áûëî ïðèíÿòî â Ñàëîíèêàõ â 2008 êàê ðóêîâîäñòâî ê äåéñòâèþ, ìû óæå íàïèñàëè â êíèãå ïî ÑÏÊß , êîòîðàÿ âûøëà ãîäîì ðàíüøå http://forums.rusmedserv.com/showthread.php?t=43211 |
#20
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Èçâèíèòå, íî ÿ íå ïðî òåîðåòè÷åñêèå âûêëàäêè, à ïðî ïðàêòè÷åñêóþ æèçíü - ïîòðåáëÿòü ÊÎÊè äåñÿòèëåòèÿìè ñîâñåì íå òàê áåçîáèäíî, êàê õîòåëîñü.
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Àíøèíà Ìàðãàðèòà Áåíèàìèíîâíà, äèðåêòîð êëèíèêè ÔåðòèÌåä, ã. Ìîñêâà. Âèöå-ïðåçèäåíò Ðîññèéñêîé Àññîöèàöèè Ðåïðîäóêöèè ×åëîâåêà, ×ëåí ñîâåòà ESHRE. Çàïèñü íà êîíñóëüòàöèþ: (495) 504-15-26, (499) 165-70-77 Äèàãíîñòèêà è ëå÷åíèå âñåõ âèäîâ áåñïëîäèÿ ìåòîäàìè ÝÊÎ, ÈÊÑÈ è äð. Ãåíåòè÷åñêàÿ äèàãíîñòèêà è ïðîôèëàêòèêà íàñëåäñòâåííûõ çàáîëåâàíèé. Äîíîðñêèå ïðîãðàììû. Ñóððîãàòíîå ìàòåðèíñòâî. Áàíê ïîëîâûõ êëåòîê. Âåäåíèå ïàöèåíòîâ îò íà÷àëà ëå÷åíèÿ áåñïëîäèÿ äî ðîäîâ. |
#21
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Óâû, Ìàðãàðèòà Áåíüÿìèíîâíà , ìû âåäü ñ íèìè ýòè òåñÿòèëåòèÿ è ïðîõîäèì -ðàâíî êàê è äðóãèå âðà÷è, à òåõíè÷åñêàÿ áëèçîñòü ê òåðàïåâòè÷åñêèé ó÷ðåæäåíèÿì äåëàåò ìåíÿ îñîáåííî ÷óâñòâèòåëüíîé ê ïðîáëåìàì ýòèõ ïàöèåíòîê
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Ã.À. Ìåëüíè÷åíêî |
#22
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Öèòàòà:
Êàòåãîðè÷åñêè íå ñîãëàñíà ñ îáÿçàòåëüíîñòüþ ñíèæåíèÿ âåñà: íåïëîõî áû è ìîæíî ïîïûòàòüñÿ, íî èñòÿçàòü áîëüíûõ ýòèì ïðåäïèñàíèåì íåäîïóñòèìî. Êñòàòè, äóìàþ, ÷òî ìíîãèå ñïåöèàëèñòû ñî ìíîé ñîãëàñÿòñÿ: ïðè èçáûòêå âåñà áåðåìåííîñòü ïîñëå ÝÊÎ íàñòóïàåò ëó÷øå, ÷åì ïðè åãî äåôèöèòå è äàæå íîðìàëüíîé ìàññå òåëà. Ê ýòîìó òåçèñó áîëåå, ÷åì ñêåïòè÷åñêè, îòíåñëàñü àñïèðàíòêà, êîòîðàÿ ïðèøëà ê íàì â öåíòð ñ òåì, ÷òîáû âûïîëíèòü ðàáîòó "Óëó÷øåíèå èñõîäîâ ÂÐÒ ó ïàöèåíòîê ñ îæèðåíèåì". Ðàáîòà ïîêàçàëà, ÷òî èìåííî ýòîé êàòåãîðèè æåíùèí ìîæíî íè÷åãî íå óëó÷øàòü. Ñòàòüÿ îïóáëèêîâàíà â N 1 Ïðîáëåì Ðåïðîäóêöèè (Îñîáåííîñòè èíäóêöèè ñóïåðîâóëÿöèè ó ïàöèåíòîê ñ èçáûòî÷íîé ìàññîé òåëà è îæèðåíèåì). Ñåãîäíÿ ïðèíÿòî ñïèñûâàòü íà îæèðåíèå è ïðè÷èíó áåñïëîäèÿ è íåóäà÷è åãî ëå÷åíèÿ, îñîáî íå íàïðÿãàÿñü ñ óñòàíîâëåíèåì èñòèííûõ ïðè÷èí. Îíî ñòàëî íåêèì æóïåëîì - âðà÷ óâèäåë òîëñòóþ æåíùèíó è òðåáóåò ñíèæåíèÿ âåñà ÄÎ òîãî, êàê ïîïûòàëñÿ ïîíÿòü, ïî÷åìó áåðåìåííîñòü íå íàñòóïàåò. Äóìàþ, ÷òî âñå íå òàê îäíîçíà÷íî è çäåñü.
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Àíøèíà Ìàðãàðèòà Áåíèàìèíîâíà, äèðåêòîð êëèíèêè ÔåðòèÌåä, ã. Ìîñêâà. Âèöå-ïðåçèäåíò Ðîññèéñêîé Àññîöèàöèè Ðåïðîäóêöèè ×åëîâåêà, ×ëåí ñîâåòà ESHRE. Çàïèñü íà êîíñóëüòàöèþ: (495) 504-15-26, (499) 165-70-77 Äèàãíîñòèêà è ëå÷åíèå âñåõ âèäîâ áåñïëîäèÿ ìåòîäàìè ÝÊÎ, ÈÊÑÈ è äð. Ãåíåòè÷åñêàÿ äèàãíîñòèêà è ïðîôèëàêòèêà íàñëåäñòâåííûõ çàáîëåâàíèé. Äîíîðñêèå ïðîãðàììû. Ñóððîãàòíîå ìàòåðèíñòâî. Áàíê ïîëîâûõ êëåòîê. Âåäåíèå ïàöèåíòîâ îò íà÷àëà ëå÷åíèÿ áåñïëîäèÿ äî ðîäîâ. |
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#23
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Öèòàòà:
è åùå äî Ê. Ëåñíîãî, â 1915 ãîäó ß. Õà÷êàðóçîâ ñäåëàë îïèñàíèå îïåðàòèâíîé íàõîäêè - óâåëè÷åííûõ ÿè÷íèêîâ - ó æåíùèí ñ îëèãîìåíîðååé (îïåðàöèÿ áûëà ïî ñîâñåì äðóãîìó ïîâîäó - ïîäîçðåíèå íà âíåìàòî÷íóþ). Òàê ÷òî è ñ òåîðèåé, è ñ ïðàêòèêîé - âñå â ïîðÿäêå. ×òî Âû ñ÷èòàåòå íåáåçîáèäíûì â ïðîäîëæèòåëüíîì ïðèåìå ÊÎÊ? Óâàæàåìûå êîëëåãè, íàø ðàçãîâîð íà÷èíàåò èäòè ñîâñåì íå â òîì êëþ÷å, êîòîðûé ïîçâîëèë áû íàéòè îáùóþ òî÷êó çðåíèÿ. Çäåñü íåò íà÷èíàþùèõ , è èìåííî çäåñü âîëåþ ñóäüáû ñîáðàëèñü ëþäè, îò êîòîðûõ çàâèñèò êàê áóäóò ëå÷èòü íàøèõ áîëüíûõ ÑÏÊß - íà ñîâðåìåííîì óðîâíå, ÷åòêî çíàÿ ñâîè âîçìîæíîñòè, îñîáåííîñòè òå÷åíèÿ çàáîëåâàíèÿ è ýôôåêòèâíîñòü ïðåïàðàòîâ, èëè æå ìû çàñòðÿíåì íà ïðîøëûõ îøèáêàõ. Äàâàéòå ãîâîðèòü î ðåàëüíûõ ïðîáëåìàõ - ïîñìîòðèòå õîòü òåìó äåêñàìåòàçîí, íàì åùå ìíîãî ÷òî íóæíî îáñóäèòü... |
#24
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Öèòàòà:
Öèòàòà:
Hum Reprod. 1998 Jun;13(6):1502-5. Links Weight loss in obese infertile women results in improvement in reproductive outcome for all forms of fertility treatment.Clark AM, Thornley B, Tomlinson L, Galletley C, Norman RJ. Department of Obstetrics and Gynaecology, The Queen Elizabeth Hospital, University of Adelaide, Woodville, SA, Australia. Obesity affects ovulation, response to fertility treatment, pregnancy rates and outcome. In this prospective study, a weight loss programme was assessed to determine whether it could help obese infertile women, irrespective of their infertility diagnosis, to achieve a viable pregnancy, ideally without further medical intervention. The subjects underwent a weekly programme aimed at lifestyle changes in relation to exercise and diet for 6 months; those that did not complete the 6 months were treated as a comparison group. Women in the study lost an average of 10.2 kg/m2, with 60 of the 67 anovulatory subjects resuming spontaneous ovulation, 52 achieving a pregnancy (18 spontaneously) and 45 a live birth. The miscarriage rate was 18%, compared to 75% for the same women prior to the programme. Psychometric measurements also improved. None of these changes occurred in the comparison group. The cost savings of the programme were considerable. Prior to the programme, the 67 women had had treatment costing a total of A$550,000 for two live births, a cost of A$275,000 per baby. After the programme, the same women had treatment costing a total of A$210,000 for 45 babies, a cost of A$4600 per baby. Thus weight loss should be considered as a first option for women who are infertile and overweight. [Ññûëêè äîñòóïíû òîëüêî çàðåãèñòðèðîâàííûì ïîëüçîâàòåëÿì ] Öèòàòà:
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#25
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íàøè áîëüíûå ãîäàìè õîäÿò ïî çàìêíóòîìó êðóãó, íå ïîëó÷àÿ ýôôåêòèâíîãî ëå÷åíèÿ, íå ðåøàÿ ñâîèõ âïîëíå ðåøàåìûõ ïðîáëåì, è èõ âðåìÿ óõîäèò, à ïîìî÷ü 6,5% íàñåëåíèÿ æåíñêîãî Ðîññèè îäèí àäåêâàòíûé âðà÷ âðÿä ëè ñìîæåò, íóæíà ïðàâèëüíî îðãàíèçîâàííàÿ ñòðóêòóðà...
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#26
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À ñîáñòâåííî êàêîé õðîíîìåòðàæ ýòîé õîäüáû ?
Ýòàï ïåðâûé - îò ïóáåðòàòà äî 18-20 ëåò , êàê ïðàâèëî , ïåðâûå æàëîáû è òóò-òî æåëàòåëåí ðàçóìíûé ñîâåò â îòíîøåíèè ïðîôèëàêòèêè îæèðåíèÿ è ïîôèëàêòèêè ñëó÷àéíîé ïðåðûâàåìîé ïî æàëàíèþ áåðåìåííîñòè (óñëîâíî ãîîâðÿ , çäåñü ÊÎÊ áóäò ðåäêî ) 20-25 ëåò, ïåðâàÿ ïîïûòêà ðåøåíèÿ âîðïîñà ôåðòèëüíîñòè - áóäåò òåì èëè èíûì ñïîñîáîì ïîëó÷åíà áåðåìåííîñòü è êîðìëåíèå - íå áóäåò ÊÎÊ, 26-35 - âòîðàÿ ïîïûòêà èëè ÊÎÊ ( èëè æå áîðüáà çà âíåøíîñòü - òå èëè èíûå àíòèàíäðîãåíû ñ íàäåæíîé êîíòðàöåïöèåé) èë ìàíèïóëÿöèè ïî ÝÊÎ ëè îïåðàòèâíûå âìåøàòåëüñòâà , òóò ðåàëüíî îêîëî 10 ëåò ìàêñèìóì 35 ëåò - ïîçäíèé ðåïðîäóêóòèâíûé, ëèáî ðåàëèçàöèÿ ðàíåå íå íàìå÷åííûõ ïëàíîâ, ëèáî ñïîíòàííîå óëó÷øåíèå, íî âñåñèëû óæå óîäÿò íà ðåøåíèå ìåòàáîëè÷åñêèõ ïðîáëåì.. Èòîãî â ðåàëüíîé ïðåêòèêå ÊÎÊ çàíèìàþò îò ñèëû 10 ëåò â æèçíè íàøèõ æåíùèí È ÿ íèêàê íå äîáüþñü ðåàëüíîé ñòàòèñòèêè õîòÿ üû ïî äèàáåòó - íó èñêîëüêî èõ óíàñ â êëèíèêå ñ äèàáåòîì 2 òèïà - ðàíåå èìåâøèõ ïîëèêèñòîç? Ñêîëüêî ó Ñûðêèíà â ðàííèì èíôàðêòîì ? Èëè íàñ çîâóò - íå äîçîâóòñÿ â íåâðîëîãèþ - äåñêàòü , ëåæèò ñ âîëîñàìè è äèàáåòîì è èíñóëüòîì?  òîì -òî è äåëî , ÷òî íàøè ( è ïîðîé íàøèõ áîëüíûõ ) óæàñû - âñþ æèçíü íà òàáëåòêàõ ñâîäÿòñÿ ê î÷åíü êîðîòêîìó ïðåèîäó â æèçíè - îò ñèëû 10 ëåò è òî ñ ïåðåðûâàìè íà òå èëè èíûå ïîïûòêè áåðåìåíåíòü
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Ã.À. Ìåëüíè÷åíêî |
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çàáàâíî ñëåäóþùåå :
ñâîåâðåìåííîå íà÷àëî ïðèåìà ÊÎÊ (åùå â ïóáåðòàòå) çàêîíîìåðíî ïîçâîëèò ïðåäóïðåäèòü ôîðìèðîâàíèå òÿæåëûõ àêíå è ïðîãðåññèþ ãèðñóòèçìà. Íî íàøè áîëüíûå, ãîâîðÿ ñ äðîæüþ â ãîëîñå î ñâîåé íåïðèãëÿäíîñòè, õîäÿò ïî êðóãó 10-12 ëåò îò ìîìåíòà ïîÿâëåíèÿ ïåðâûõ ïðîáëåì äî íà÷àëà àäåêâàòíîãî ëå÷åíèÿ. Çà ýòî âðåìÿ èç íà÷èíàþùåãî æèçíü ïîäðîñòêà óñïåâàåò ñôîðìèðîâàòüñÿ çàêîìïëåêñîâàííàÿ áàðûøíÿ, óâåðåííàÿ â ñîáñòâåííîé óðîäëèâîñòè. È íè÷òî íà ñâåòå çà âñþ åå æèçíü äàëåå íå óáåäèò åå, ÷òî ïðè ìèíèìàëüíûõ óñèëèÿõ ñ åå ñòîðîíû (ðåãóëÿðíîì ïðèåìå ÊÎÊ + ýïèëÿöèÿ) îíà ïðåâðàùàåòñÿ â ïðåêðàñíîãî ëåáåäÿ. Åñëè ïðèåì ÊÎÊ íà÷àò äî ïîÿâëåíèÿ ãèðñóòèçìà, òî ïåðèîä ïðåâðàùåíèÿ ãàäêîãî óòåíêà â ëåáåäÿ çàíèìàåò ðîâíî 1 ìåñÿö. Ïðîáëåìà îðãàíèçàöèîííàÿ îò ìàíèôåñòàöèè ÑÏÊß äî íà÷àëà àäåêâàòíîãî ëå÷åíèÿ ïðîõîäèò 10-12 ëåò. Ïîýòîìó ñòîèìîñòü ëå÷åíèÿ ÑÏÊß âîçðàñòàåò ìíîãîêðàòíî (âìåñòî ïðîñòîãî ïðèåìà ÊÎÊ - êîñìåòîëîã, äèåòîëîã, ïñèõîòåðàïåâò, ðåïðîäóêòîëîã ...) Íàäåæäû íà êîíå÷íîñòü ïåðåõîäíîãî âîçðàñòà ñìåíÿþòñÿ ÷àñàìè, ïðîâåäåííûìè ó êîñìåòîëîãà , è âðåìåíè íà èìåþùèé ñìûñë ïðèåì ÊÎÊ îñòàåòñÿ ëèøü - ïàðà ëåò. |
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 ìîåé ïðàêòèêå - ñîòíè ïàöèåíòîâ, êîòîðûì ÊÎÊè íàçíà÷àëè ñ 16 - 18 ëåò. Àêíå, ãèðñóòèçì, îæèðåíèå, íåîáðàòèìûå íàðóøåíèÿ öèêëà, àíîâóëÿöèÿ - âñ¸ íà ìåñòå. ßâëÿåòñÿ ëè ýòî ðåçóëüòàòîì ñëèøêîì ðàííåãî íàçíà÷åíèÿ ÊÎÊîâ, íå çíàþ. Íî òî, ÷òî îíè íå ïîìîãëè, áåññïîðíî
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Àíøèíà Ìàðãàðèòà Áåíèàìèíîâíà, äèðåêòîð êëèíèêè ÔåðòèÌåä, ã. Ìîñêâà. Âèöå-ïðåçèäåíò Ðîññèéñêîé Àññîöèàöèè Ðåïðîäóêöèè ×åëîâåêà, ×ëåí ñîâåòà ESHRE. Çàïèñü íà êîíñóëüòàöèþ: (495) 504-15-26, (499) 165-70-77 Äèàãíîñòèêà è ëå÷åíèå âñåõ âèäîâ áåñïëîäèÿ ìåòîäàìè ÝÊÎ, ÈÊÑÈ è äð. Ãåíåòè÷åñêàÿ äèàãíîñòèêà è ïðîôèëàêòèêà íàñëåäñòâåííûõ çàáîëåâàíèé. Äîíîðñêèå ïðîãðàììû. Ñóððîãàòíîå ìàòåðèíñòâî. Áàíê ïîëîâûõ êëåòîê. Âåäåíèå ïàöèåíòîâ îò íà÷àëà ëå÷åíèÿ áåñïëîäèÿ äî ðîäîâ. |
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Öèòàòà:
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Àíøèíà Ìàðãàðèòà Áåíèàìèíîâíà, äèðåêòîð êëèíèêè ÔåðòèÌåä, ã. Ìîñêâà. Âèöå-ïðåçèäåíò Ðîññèéñêîé Àññîöèàöèè Ðåïðîäóêöèè ×åëîâåêà, ×ëåí ñîâåòà ESHRE. Çàïèñü íà êîíñóëüòàöèþ: (495) 504-15-26, (499) 165-70-77 Äèàãíîñòèêà è ëå÷åíèå âñåõ âèäîâ áåñïëîäèÿ ìåòîäàìè ÝÊÎ, ÈÊÑÈ è äð. Ãåíåòè÷åñêàÿ äèàãíîñòèêà è ïðîôèëàêòèêà íàñëåäñòâåííûõ çàáîëåâàíèé. Äîíîðñêèå ïðîãðàììû. Ñóððîãàòíîå ìàòåðèíñòâî. Áàíê ïîëîâûõ êëåòîê. Âåäåíèå ïàöèåíòîâ îò íà÷àëà ëå÷åíèÿ áåñïëîäèÿ äî ðîäîâ. |
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Öèòàòà:
Ëå÷åíèå îæèðåíèÿ - íåîáõîäèìîå óñëîâèå ëå÷åíèÿ áîëüíûõ ñ ÑÏÊß è îæèðåíèåì. Àäåêâàòíûå ìåòîäû ëå÷åíèÿ îæèðåíèÿ íå îòíîñÿòñÿ ê ìåòîäàì, îäîáðåííûì èíêâèçèöèåé, è èñòÿçàíèåì íå ÿâëÿþòñÿ. Ñíèæåíèå âåñà - íåïðîñòàÿ è äîëãàÿ ðàáîòà. È âðà÷à, è ïàöèåíòà. Áîëåå òîãî, îòñóòñòâèå ýôôåêòà îò ëå÷åíèÿ îæèðåíèÿ - ñâèäåòåëüñòâî ÿâíûõ íåðåøåííûõ ïñèõè÷åñêèõ ïðîáëåì. Ëå÷åíèå âûðàæåííîãî îæèðåíèÿ áåç ó÷àñòèÿ ïñèõèàòðà áåñïåðñïåêòèâíî â ïðèíöèïå. Ïåðååäàíèå - çàùèòíàÿ ðåàêöèÿ îðãàíèçìà, êîòîðûé íå ìîæåò íàéòè ýêîëîãè÷íûé âûõîä èç òîé èëè èíîé æèçíåííîé êîëëèçèè. È, óâû, äàëåêî íå êàæäûé ïñèõèàòð ãîòîâ âçÿòü íà ñåáÿ ïîäîáíóþ íîøó - áîëüíîãî ñ îæèðåíèåì.  èòîãå ñëåäóþùåå - ïðåæäå ÷åì ëå÷èòü áîëüíîãî ñ îæèðåíèåì, íàäî çíàòü, êàê ýòî äåëàåòñÿ, - íàäî áûòü çíàêîìûì ñ ïðàâèëàìè èãðû. Ñåãîäíÿ Ìèíçäðàâ îáÿçàë âñåõ âðà÷åé, çàíèìàþùèõñÿ ñíèæåíèåì âåñà, èìåòü ãîñóäàðñòâåííûé ñåðòèôèêàò - íàì ïðèõîäèòñÿ çàíèìàòüñÿ îáó÷åíèåì âðà÷åé â ÝÍÖ. Ïðîâîäèò ñåðòèôèêàöèîííûå öèêëû êàôåäðà ýíäîêðèíîëîãèè ÔÏÏÎ ÌÌÀ. |